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Thread: Anybody with experience self paying for equipment that medicare has denied?

  1. #1

    Anybody with experience self paying for equipment that medicare has denied?

    Does anybody have any experience with the ins and outs of self paying for a power chair twice denied by Medicare?--how could one find out what Medicare would have paid, so as to be in a bargaining position with the supplier? And also, what would be the implications/repercussions of self-paying? Would it be possible to get the new chair certified as the "primary" chair (and thus eligible for Medicare-paid repairs), or would you be out of luck on this issue? I'd appreciate hearing from anybody who has done it. Thank you. RKA

  2. #2
    According to CMS my wife's power chair was billed at $29750, Medicare approved $18570, and they paid $14860. We paid power elevation out of pocket plus the 20%.

    I wish I had just looked for a good used chair. Since we bought it, I've seen several used chairs advertised for less than our copay which I thought were superior to what we got. Starting with new has not been impressive. Barely 100 miles on it now and it sounds like it is running over marbles. It left her stranded once due to poor routing of the harnesses (pinched and severed) which took them weeks to fix. The tilt/elevation is all creaky with no good way to oil any of the pivot points. The power foot rests are absolutely worthless (don't even have them on the chair). The cushion was sized wrong by the DME and I've already bought a new one for cash. In other words, used would probably not have been any more trouble.

  3. #3
    A person can usually find good, fairly new chairs and equipment at a Lions Club. We have a great one here, Someof the chairs are unbeleivably in good shape.

    MS is right on about looking for deals. I always ask about the difference for cash vs. Medicare or insurance. Many will give a much better deal if paying cash; there is so much paperwork avoided when doing so.

  4. #4

    I do both self pay used and insurance

    In my 17 yr sci career, I do both insurance and self pay,( barely used class 4 power chairs).

    The good thing about insurance chairs is the service, battery and tire replacement. I have always had great DMEs that promptly come to my home and have always fixed any problems.

    I keep my self pay chairs for backup and one is waterproof for rainy days.

    Someday if or when insurance stops funding anything, I want to have enough mobility devices to last the rest of my life. I have stocked up on spare ebay tires, I'll just need new battery replacements and ebay parts. I have tools, service manuals, and reliable help if I need it.

  5. #5
    If Medicare denies the chair, they will not pay for the repairs or up keep.

    My $.02
    I would recommend you decide what you want/need, then start shopping. Let your DME know what you are looking for and ask them if they have a demo or a return they will sell for cash. Check ebay and craigslist for postings that match what you are looking for. Also, post your "wish/want" here on this forum. Good luck.

  6. #6
    Thanks all for comments, suggestions, responses. . . i really do appreciate that there are people in similar circumstances to talk to on this site. I was particularly taken with the comment by JohnW on having stockpiled enough "mobility" to last the rest of life. My MS husband, and I as caregiver, are 25 yrs into wheelchairs at this point, and I think we have enough broken down, worn-out, saved for emergencies, saved just in case equipment overflowing house and garage to last more than a lifetime . . . but, of course, what one always needs at the moment is a decent functional chair; we're already on our 2nd DME supplier for this one, and I have just found out they (apparently) went broke & have been taken over by yet another DME company.

    On a more humerous note, & thinking about buying equipment on one's own, has anybody ever started a thread detailing the stupidest piece of equipment they ever sprung for? In our case, I'd say it was an old-style Hoveround that twirled around on a base and caught my husband's imagination at a show . . .lasted less than a year, I think. . .

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